Opioid (narcotic) analgesics are pain relievers which are chemically related to morphine and used for a variety of conditions and circumstances, including the treatment of migraine when other medications fail or are ineffective. Opioids work by blocking pain messages sent to the brain, thereby altering the brain’s perception of pain. As a powerful and highly effective pain reliever, opioids continue to be commonly prescribed for a number of pain states.
Opioids for the Treatment of Migraine

In treating migraine, opioids are reserved for patients with moderate to severe pain who do not respond to non-opioid medications. Opioids are also appropriate for acute treatment of migraine headaches in patients who cannot tolerate other migraine medications, or who may find them harmful. To minimize the potential for rebound headaches, medication abuse and dependence, opioids should only be used in these situations.

For those patients who find opioids are an appropriate treatment for migraine, oral opioids may be considered when sedation side effects will not put the patient’s work or daily activities at risk and the risk for potential medication abuse has been addressed. Non-orally administered opioids may be considered for rescue therapy. Rescue therapy medications are used to relieve symptoms of migraine when acute therapy does not work. Opioids used as rescue therapy must be administered under the supervision of a physician and require the same side effect considerations as opioids used in the treatment of migraine.

Proper Use of Opioids

Because several opioid analgesics relieve pain, recommended doses for the treatment of migraine vary. However, patients using opioids to relieve migraine symptoms should remember the following:

  • Take the medication only as directed by a medical doctor or other qualified healthcare professional
  • Evaluate the benefits and risks of each medication with a healthcare provider before it is prescribed
  • Do not increase the recommended dose or frequency of opioids
  • Do not take opioids for a longer time than a healthcare provider has directed
  • Consult with a healthcare provider before abruptly ending opioid use

Risks Associated with Opioids

Opioid analgesics should be taken only with appropriate monitoring. Improper use can lead to increased tolerance, causing potential physical dependence and possible addiction:

Tolerance

Chronic opioid use may result in increased tolerance, where the body adapts to the presence of opioids and the initial prescribed dose becomes less effective. Eventually higher doses of medication may be needed to achieve the same level of pain relief. Increased tolerance is not a sign of addiction.

Physical Dependence

After taking opioids for a period of time, the body may get used to the presence of the drug. If use of opioids is abruptly stopped, withdrawal symptoms may occur. It is best to gradually decrease the dose of the drug under a healthcare provider’s supervision to minimize withdrawal symptoms. Withdrawal symptoms include craving for the drug, restlessness, moodiness, insomnia, yawning, abdominal cramps, diarrhea and goose bumps.

Addiction

Addiction occurs when opioid use continues despite serious consequences to a person’s body, relationships, career and other aspects of life. Warning signs of addiction include taking more pain medication than a doctor has prescribed, requesting prescriptions from multiple doctors, use of medication to deal with other problems unrelated to pain, and friends or family expressing concern over one’s overuse of pain medication.

Opioid Analgesic Side Effects

While opioids are powerful pain relievers, they also have side effects that vary in intensity and level of debilitation, depending on the opioid and dose prescribed. The most common side effects include:

  • Drowsiness
  • Dizziness or light-headedness
  • Euphoria or false sense of well-being
  • Nausea
  • Vomiting
  • Dryness of mouth
  • Constipation
  • Dilated pupils
  • Slow shallow breathing
  • Retention of urine
  • Lowered blood pressure
  • Flushed or warm skin
  • Itching
  • Slow heart rate
  • Low body temperature
  • Feelings of confusion

It is important to note that opioids should not be combined with alcohol and/or other central nervous system depressants.Commonly Abused Opioids According to the National Institute of Drug Abuse, the most commonly abused opioids include:

  • Codeine
  • Fentanyl (Duragesic®, others)
  • Hydrocodone (Vicodin®, Lortab®, others)
  • Hydromorphone (Dilaudid®, others)
  • Meperidine (Demerol®, others)
  • Morphine (MS Contin®, Kadian®, others)
  • Oxycodone (OxyContin®, Percocet®, others)